Transforming Narratives: A Change Event in Constructivist Family Therapy

Abstract

One important clinical task in family therapy involves transforming the client's construction of the presenting problem from an individual, intrapersonal view to an interpersonal, relational, or systemic one (Sluzki, 1992). To study the transformation process in initial sessions, we sampled 8 families in which the referring parent requested help for a child's problem. The 8 therapists, trained and experienced in Sluzki's (1992) narrative approach, attempted to facilitate a transformation in the parents' initial construction of the problem. In 4 sessions, the transformation was independently judged to be successful by the therapist and observers, while in 4 other sessions the transformation was judged to be unsuccessful. Videotapes of the 8 interviews were analyzed qualitatively, and the parents' verbatim descriptions of the problem were coded using the Cognitive Constructions Coding System (Friedlander, 1995). We compared the successful and the unsuccessful sessions and developed a conceptual model of the successful transformation process that included client performances as well as therapist operations (Greenberg, 1986). While many elements in the model were consistent with Sluzki's (1992) "blue-print" transformation, several new elements were added. Practical implications are described, along with limitations and recommendations for future research.

What is narrative therapy and what is it not? The usefulness of Q methodology to explore accounts of White and Epston's (1990) approach to narrative therapy

“…It may be that techniques associated with 'reauthoring' provide a contrast to the 'defi cit' approach (Gergen, 1990), i.e., the focus on 'problems' and the need to 'fi x' people, common in therapeutic discourse. It may be that these techniques contribute to outcomes and a 'shift to hope' by developing personal agency (O'Connor et al, 1997) and focusing on the 'exceptions' and strengths of family members (Coulehan et al, 1998). However, it is the areas of debate and difference identifi ed that may have the greatest infl uence in how practitioners apply narrative approaches in practice, hence contributing the most variance when trying to establish the effi cacy of the approach.…”

“…Within such research, attention to process as well as outcomes is important as it allows the identifi cation of 'the active ingredients of psychotherapy and the mechanisms of change' (Kopta, Lueger, Saunders, & Howard, 1999, p. 7). While the majority of these studies report positive outcomes, they also point to the wide diversity in which 'narrative therapy' is being defi ned (e.g., 'free association narrative ', Elliot et al, 2007; 'family attachment narrative therapy', May, 2005) and the ways it is being integrated with other approaches (e.g., 'constructivist control mastery', Lieb & Kanofsky, 2003;'behavioural monitoring', Besa, 1994; 'systemic therapy ' Coulehan et al, 1998), thus giving further evidence to the eclectic and integrationist nature of this therapy (Flaskas, 2002;Pinsof & Wynne, 2000) and posing more challenges to a research paradigm attracted to 'model fi delity'. While it is important to recognize that these researchers have been bold enough to venture into a new area of psychotherapy outcome research, their attempts can also be criticized for many of the limitations so frequently encountered in such initial research endeavours.…”

“…They concluded that prediction of outcome was a function of treatment, but only as an additive function of patient, relationship and patienttreatment variables. Other studies have been typical of the exploratory, small-scale research described by Roth and Fonagy (1996) and Salkovskis (1985) to develop theory, practise techniques and investigate outcomes (e.g., Besa, 1994;Coulehan, Friedlander, & Heatherington, 1998;DiLollo, Neimeyer & Manning, 2002;Elliot, Loewenthal, & Greenwood, 2007;Kogan & Gale, 1997;May, 2005;O'Connor, Meakes, Pickering, & Schuman, 1997). Within such research, attention to process as well as outcomes is important as it allows the identifi cation of 'the active ingredients of psychotherapy and the mechanisms of change' (Kopta, Lueger, Saunders, & Howard, 1999, p. 7).…”

A thematic review of the family therapy journals of 1998

“…In an excellent research paper, Coulehan et al (1998) investigated how narrative therapy transforms the perspectives of families. These researchers, who have also extensively studied the process of family therapy (Friedlander et al, 1994), analysed the way families talked about the problem that brought them to therapy both before, during and after a session of narrative therapy.…”

The Complementary Domains of Outcome and Process Research

“…Despite the work done over years in process research using the clients' verbal content to determine progress in therapy, as well as the nature of the communication within the family, this type of research is still a minefield, is often flawed methodologically, and is not user friendly. Better examples of this form of research are the work done with studying expressed emotion in families where a member has schizophrenia (Falloon, 1984), and the more recent work that attempts to identify whether progress in therapy can be determined by the narratives of the families involved in treatment (Coulehan, Friedlander, and Heatherington, 1998). Both forms of research used the verbal information in the sessions as the primary data.…”